The purpose of this career development award is to enable Dr. Fox to develop the requisite skills to become an independent investigator, scholar, and resource in transplant ethics and policy. Through a structured program of didactic training and mentored research, the applicant proposes to develop an "evidence-based" ethical analysis of organ allocation policy, with specific reference to heart transplantation. This ethical analysis will be predicated on the development of skills in health services/outcomes research relevant to transplantation. The overall goal of this project is to provide an evidence-based ethical analysis of allocation policy informed by data regarding cardiac transplantation outcomes, and to determine if the impact of the policy changes enacted matches the stated goals of allocation policy. The fundamental hypothesis to be tested is that the changes in the allocation policy for heart transplantation have not produced outcomes consistent with the stated goals for transplantation. This hypothesis will be systematically pursued through the following five specific aims: 1) to develop methods for analyzing clinical outcomes for patients listed for cardiac transplantation in the United States, using the Scientific Registry of Transplant Recipients database; 2) to examine changes over time in the allocation policy regarding heart transplantation, with particular attention to how criteria defining medical urgency impact allocation decisions; 3) to evaluate the impact of changes in heart allocation policies with respect to various outcomes (pretransplant mortality, post-transplant survival, and the need for re-transplantation); 4) to examine differences in value assigned to possible outcomes, as reflected in preferences for allocation strategies, among patients and non patients, transplant professionals and other health care providers; and 5) to develop a policy analysis of other potential models for heart allocation to determine their clinical, political, and moral viability. Upon completion of the career development award, Dr. Fox will be able to function as an independent investigator in the interface between ethics and health services research. [unreadable] [unreadable]